Duke PA Salt and Water
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| Water constitutes __% of total body weight in humans | 60
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| Total body water is inversely proportional to the amount of __ | body fat
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| __ are the major cations of the intracellular space | potassium and magnesium
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| __ are the major anions of the intracellular space | phosphate and protein
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| __ are the major anions of the extracellular space | chloride and bicarbonate
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| __ is the major cation of the extracellular space | sodium
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| __ determines the movement of fluid across the cell membrane | osmotic gradient
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| Except for transient changes, the intracellular and extracellular fluid compartments are in __ | osmotic equilibrium
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| The transfer of fluid between the vascular and interstitial compartments occurs across the capillary wall and is governed by the balance between ___ | hydrostatic pressure gradients and plasma oncotic pressure gradients
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| Hemodynamic alterations to a perceived volume reduction | tachycardia, vasoconstriction, venoconstriction
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| Renal conservation of salt and water lags behind hemodynamic alterations to a perceived volume reduction by __ hours | 12-24
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| __ promotes salt and water retention in the kidneys | ADH
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| __ is released from the atrial myocytes in response to atrial stretch associated with volume expansion | atrial natriuretic peptide
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| __ increases GFR and inhibits sodium reabsorption in the collecting ducts | atrial natriuretic peptide
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| __% of total body blood is in the atrial compartment | 15
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| True volume depletion | decrease in effective circulating volume and extracellular fluid volume
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| When volume depletion occurs from renal losses the urine is inappropriately __ | dilute and sometimes rich in salt
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| Mild volume depletion may be associated with __ | orthostatic dizziness and tachycardia
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| Patients with severe volume depletion may exhibit __ | vasoconstriction, hypotension, mental obtundation, cool extremities, and negligible urine output
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| vasoconstrictor hormones released in response to hypovolemia | catecholamine, angiotensin II
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| if doubt exists about the state of hydration, measurement of the pulmonary __ permits assessment of the intravascular volume status | capillary wedge pressure
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| nearly all of the volume of solution containing __ are retained in the extrarenal space | 0.9% sodium chloride and colloid
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| __ are the preferred parenteral solutions for the treatment of hypovolemia | 0.9% sodium chloride and colloid
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| only 1/3 of infused __ remains in the extracellular compartment | 5% glucose in water (D5W)
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| __ occurs when salt and water intake exceeds renal and extrarenal losses | volume expansion
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| sever hypoalbuminemia associated with liver disease, nephrotic syndrome, or severe malnutrition may lead to __ | edema
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| the mainstay in treating volume excess is ___ | dietary sodium restriction in combination with diuretics
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| Diuretics enhance | natriuresis by inhibiting the reabsorption of sodium and water
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| most patients with nephrotic syndrome have increased effective circulating volume resulting from | primary renal sodium retention
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| ___ inhibit sodium, chloride and potassium cotransporter of the thick ascending loop of henle | loop diuretics (furosemide, bumetanide)
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| loop diuretics __ calcium excretion | promote
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| thiazide diuretics __ calcium excretion | decrease
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| __inhibit the sodium and chloride cotransporter of the distal tubule | thiazide diurtetics
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| __ are useful in managing hypercalcemia | thiazide diuretics
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| __ are useful in managing calcium stone formation | loop diuretics
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| potassium sparing diuretics | spironolactone (aldosterone agonist), amiloride (sodium channel blocker)
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| decreases sodium reabsorption in the cortical collecting duct | spironolactone (aldosterone agonist), amiloride (sodium channel blocker)
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| because __ is the major cation in ght ECF, disorders of osmolality are generally reflected by and abnormal __ concentration | sodium
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| __ causes renal water conservation by increasing water permeability and water reabsorption in the collecting ducts | ADH
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| baroreceptors in the venous and arterial circulation stimulate __ release throu neuronal pathways when the EDF volume is reduced by about 10% | ADH
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| Hyperglycemia and the use of mannitol may result in __ because of a water shift from the intracellular to extracellular space | hyponatremia
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| most hyponatremic disorders are associated with | hypo-osmolality
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| failure to suppress ADH secretion in response to hypotonicity | SIADH
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| in most instances hypernatremia is caused by __ rather than by sodium gain | excess water loss
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| __ is a powerful stimulus for thirst | hypertonicity of the plasma
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| patients unable to sense thirst or with a lack of available water may develop | hypernatremia
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| a disorder in which the collecting tubule is impermeable to water | diabetes insipidus
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| hypernatremia that is associated with hypovolemia implies __ in addition to the water deficit | a sodium deficit
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| hypernatremia that is associated with hypovolemia requires __ | isotonic saline infusion
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| administration of fluids that are __ relative to the urine corrects hypernatremia | hypotonic
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| the ascending limb of the loop of henle is __ to water | impermeable
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| the ascending limb of the loop of henle is __ to NaCl | permeable
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| the descending limb of the loop of henle is __ to water | permeable
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| if the blood is hypoosmolar then ADH will be turned __ | off
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| if the blood is hyperosmolar then ADH will be turned __ | on
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| if the blood is hypoosmolar and ADH is turned on this is called __ | SIADH
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| function of ADH | increases water retention and results in a more concentrated urine, increases blood volume, decreases serum osmolalit
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| __ is a powerful vasoconstricor and increases cardiac output | angiotensin II
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| __ initiates the active transport of Na from the distal tubules and collecing ducts into the bloodstream. this promotes the reabsorption of water | aldosterone
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| major stimulus for angiotensin II | low ECV, beta-adrenergics (via renin release)
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| major site of action of angiotensin II | proximal convoluted tubule
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| major stimulation of aldosterone | angiotensin II, hyperkalemia
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| major site of action of aldosterone | cortical distal nephron
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| major stimulus for atrial naturetic factor | vascular volume expansion
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| major site of action for atrial naturetic factor | GFR, medullary CD
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| __% of body water is in the ICF | 60
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| __% of body water is in the ECF | 40
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| __% of ECF is intravascular | 20
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| __% of ECF is interstitial | 80
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| effective circulating volume is the same as | intravascular volume
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| hyperosmolar is the same thing as | less water
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| hypoosmolar is the same thing as | more water
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| effective plasma osmolality is calculated by | 2Na + glucose/18
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| nomral saline is given for | intravascular fluid volume resuscitation
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| D5W is given for | dehydration
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| __ is a true vascular volume expander | packed red blood cells
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| if the serum is hyperosmotic the urine should be __ | hyperosmotic
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| if the serum is hypoosmotic the urine should be __ | hypoosmotic
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| if the kidneys are unable to to concentrate urine this is called | diabetes insipidus
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| in SIADH if the serum osmolality is low the urine osmolality will be | high
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| in DI or low ADH if the serum osmolality is high then the urine osmolality will be | low
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| if the patient is hyponatremic, hypovolemic treat with | normal saline
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| if the patient is hyponatremic and euvolemic treat with | H2O restriction, hypertonic Na
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| if the patient is hyponatremic and hypervolemic treat with | H2O and Na restriction
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| when a patient is in DKA you give them __ until the anion gap normalizes then you give them insulin | fluids
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| in hyponatremia always correct sodium to __ | 125
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| in hyponatremia correct the sodium at __ mEq/L/hr | 0.5
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| if you correct hyponatremia too fast you can cause | demylenation of neurons in the Pons
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| hypernatremia and hypovolmia treat with | hypotonic saline
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| hypernatremia and euvolemia treat with | water replacement
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| hypernatremia and hypervolemia treat with | water and diuretics
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| don't use __ when treating diabetes insipidus | loop diuretics
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| major complication of rapid correction of chronic hypernatremia is __ | cerebral edema
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| safe initial correction of hypernatremia is at the rate of __mEq/L/hr | 0.5
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| hypernatremia with severe hypovolemia treat with | 0.9% saline
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| with a patient that is hypernatremic bring the Na to | 140
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